One element of the Affordable Care Act (Section 640) is to allow CMS to conduct ‘enhanced enrollment screening’. In short, any provider or a ‘5% or more owner of a company’ that is considered a high level of risk may be asked to supply fingerprints to a third party agency. The third party agency (called the Fingerprint-Based Background Check Contractor or FBBC) will then send the fingerprints to the FBI for processing. The FBI will then compile a background history based upon the fingerprints and will share their results with the FBBC.
CMS recently selected Accurate Biometrics located in Chicago, Illinois to be the FBBC for this program. We expect some new Medicare participation applications that are considered high risk to begin receiving requests for fingerprints. Currently high risk providers are listed as home health agencies and DME providers.
Physician practices are noted as being in a low risk category unless the provider or practice has had billing privileges revoked by Medicare in the past ten years; the provider or practice has been terminated or precluded from billing Medicaid; and a few other small reasons. It is interesting to note that it is CMS that defines who is and who is not considered a high risk provider. Provider types that are currently considered low or moderate risk could be added to the high risk group by bureaucratic fiat.
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